11.1_Atch_1_-_Modeling_and_Effects_CDRLs.pdf

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Attached to
Open Proposal Research Announcement for HPEM - Modeling & Effects Federal contract opportunity
Solicitation number
FA9451-18-S-0004
Issued by
Department of the Air Force Materiel Command Research Laboratory

About this file

This is a Contract Data Requirements List (CDRL) for an Open Broad Agency Announcement (BAA) from the Air Force Research Laboratory regarding modeling and effects. The CDRL outlines fifteen required data items to be delivered under any resultant task orders, including status reports, scientific and technical reports, software documentation, test plans, and inventory reports. Delivery methods, markings, and distribution requirements are specified for each data item. Relevant information must be provided on CD-ROM or electronically using Microsoft formats.

Potential DD Form 1423, Contract Data Requirements Lists

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CONTRACT DATA REQUIREMENTS LIST (Data Item) Form Approval OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA

EXHIBIT ......................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0004

CATEGORY ................................... : OTHER F. CONTRACTOR :

1. DATA ITEM NO. ...................... : A001

2. TITLE OF DATA ITEM ........... : Presentation Materials

3. SUBTITLE ................................. : N/A

4. AUTHORITY ............................ : DI-ADMN-81373 (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : AFRL/RDHE 9. DIST. STATEMENT REQUIRED ..... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : Lt 10. FREQUENCY ..................................... : (See Block 16) 13. DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ....................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/PM’s Office 1

AFRL Det 8/RVKDP Lt

ACO Lt

15.TOTAL: 0 2

16. REMARKS

Block 4: Format of materials will be in accordance with paragraphs 3.1 and 10.1 of the DATA ITEM DESCRIPTION.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD

5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

Distribution Statement B if containing Proprietary Information:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to

Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

TO THE BOTTOM OF EACH PAGE OF THE REPORT.)

Or the Distribution Statement C if containing no proprietary information:

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

DESTRUCTION NOTICE – For unclassified, limited documents, destroy by any method that will prevent disclosure of content or reconstruction of the document.

Block 10, 12 and 13: The contractor will deliver formal briefing presentation materials three (3) working days prior to the presentation. No data item is required for informal briefings.

Block 14: Deliver an electronic version (Microsoft format) on CD-ROM (CD-R) or other appropriate electronic means, along with a hard copy to the PM and RDH Business Office.

When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

17. PRICE GROUP: 18. ESTIMATED TOTAL PRICE:

G. PREPARED BY:

Andrew Greenwood

I. APPROVED BY: Mark Cruz

H. DATE: 7 December 2017 J. DATE: 21 December 2017

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 1 of 15 pages

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA

EXHIBIT ......................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0004

CATEGORY ................................... : OTHER F. CONTRACTOR ...... :

1. DATA ITEM NO. ...................... : A002

2. TITLE OF DATA ITEM ........... : Status Report

3. SUBTITLE ................................. : Technical Status Report (TSR)

4. AUTHORITY ............................ : DI-MGMT-80368A (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : AFRL/RHDE 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : LT 10. FREQUENCY……………………...: (See Block 16) 13. DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRLPM’s Office 1

15. TOTAL: 0 2

Blk 4: Tailored: Para 3.2.3 Itemized man-hours and costs. Itemized man-hour and cost expenditure incurred for the reporting period by category and task, and Accounting Classification Reference Number (ACRN); total contractual expenditures, and fund remaining as of the reporting date.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD

5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to

Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

DESTRUCTION NOTICE – For unclassified, limited documents, destroy by any method that will prevent disclosure of content or reconstruction of the document.

Block 10, 12 and 13: Provide quarterly status reports NLT fifteen (15) calendar days following the close of the contractor’s monthly accounting period for the last month of the quarter through completion of the contract technical period of performance, with a final status report after contract completion. Reports shall be summarized by contract through contract completion.

Block 14: Deliver an electronic version (Microsoft format) on CD-ROM (CD-R) or other appropriate electronic means, along with a hard copy to the

PM and RDH Business Office. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

17. PRICE GROUP: 18. ESTIMATED TOTAL PRICE:

G. PREPARED BY:

Andrew Greenwood

I. APPROVED BY: Mark Cruz

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 2 of 15 pages

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA

EXHIBIT ......................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0004

CATEGORY ................................... : OTHER F. CONTRACTOR ...... :

1. DATA ITEM NO. ...................... : A003

2. TITLE OF DATA ITEM ........... : Scientific and Technical Report (S&T)

3. SUBTITLE ................................. : Final Report

4. AUTHORITY ............................ : DI-MISC-80711A (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : AFRL/RHDE 9. DIST. STATEMENT REQUIRED ....... : (See (Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : DD 10. FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : A 11. AS OF DATE ......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

Final CRC

AFRL/RDH Business Office 1 1

AFRL/PM’s Office 1 1

AFRL Det 8 / RVKDP Lt Lt

ACO Lt Lt

15.TOTAL: 2 2

THE REPORT WILL BE PUBLISHED WITH THE DEFENSE TECHNICAL INFORMATION CENTER (DTIC) BY AFRL/RDM. Under no circumstances shall the contractor deliver either the draft or the final technical report to DTIC.

Block 4: GUIDANCE FOR PREPARATION OF THE REPORT: The Scientific and Technical Report shall be prepared I.A.W. the most current AFRL

ANSI/NISO Standard Z39.18-2005, or other most current report preparation guidance. The contractor shall complete the most current SF 298 Report Documentation

Page, and deliver it with the report. The contractor shall complete the following blocks of the SF 298: Blocks 2-5a, 6, 7, 8 and 13 (if applicable), and 14-16c., and deliver it with the report as part of the report deliverable IAW CLIN 0002. Incomplete reports will be immediately returned to the contractor. Following AFRL technical and STINFO reviews, any revisions required will be returned to the contractor. NOTE: The report preparation guidance, SF 298 are available at:

http://www.afrlnewmexico.com/stinfo-1.

The contractor shall deliver two editable electronic copies of the report. The electronic copies shall be an editable .pdf file and the most current version of Microsoft Word. A CD-

ROM (CD-R) is the acceptable media for submittal (CD-RWs are not acceptable). Electronic media shall be marked I.A.W. the AFRL ANSI/NISO Standard Z39.18-2005 guidelines, or other most current report preparation guidance. Submission via unencrypted or unsecure email is not permitted.

Block 7: UPON NOTIFICATION OF ACCEPTANCE OF THE SCIENTIFIC AND TECHNICAL REPORT FROM THE PROGRAM OFFICE, the contractor shall deliver the final Receiving Report (DD Form 250) in WAWF. In preparing the final DD Form 250, code the shipment number with a “Z.” Do not upload the Scientific and Technical Report into WAWF or DTIC. NOTE: SUBMITTAL OF THE DD FORM 250Z PRIOR TO ACCEPTANCE NOTIFICATION WILL RESULT IN REJECTION OF THE DD FORM

250Z FINAL RECEIVING REPORT.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD 5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air Force Research

Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration

Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of

DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE OF THE REPORT.)

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air Force

Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration

Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE OF THE REPORT.)

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.”

Blocks 10 - 13: The contractor shall deliver the Final Scientific and Technical Report, in draft, no later than the date specified in the Schedule, CLIN 0002. The USAF will review, edit and return the draft no later than the date specified in the Schedule, CLIN 0002. Upon receipt of the reviewed and edited draft, the contractor shall deliver the final version of the report no later than the date specified in the Schedule, CLIN 0002.

Block 14: The contractor shall distribute the Scientific and Technical Report (final/CRC version(s)) in accordance with Block 14A. When the addressee’s copy is identified by

“Lt”, send only a copy of the transmittal letter to that addressee.

17. PRICE GROUP: 18.ESTIMATED TOTAL PRICE:

G. PREPARED BY:

Andrew Greenwood

I. APPROVED BY: Mark Cruz

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 3 of 15 pages http://www.afrlnewmexico.com/stinfo-1

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA

B. EXHIBIT .................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0004

C. CATEGORY .............................. : OTHER F. CONTRACTOR ...... :

1. DATA ITEM NO. ...................... : A004

2. TITLE OF DATA ITEM ........... : Developmental Design Drawings and Associated Lists

3. SUBTITLE ................................. : N/A

4. AUTHORITY ............................ : DI-SESS-81002F (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : AFRL/RHDE 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : Lt 10. FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/PM’s Office 1

15.TOTAL: 2

Block 4: Paragraph 3. Format. Developmental Design Drawings/Models and Associated Lists shall be in the contractor's format. Tailor will be specified in the task order/contract.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD

5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

"Distribution authorized to US Government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to

Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

“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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 240 I et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25."

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776. . (ADD THIS

ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE OF THE REPORT.)

“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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD “WARNING: EXPORT CONTROLLED” TO THE

BOTTOM OF EVERY PG OF THE REPORT.)

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.”

Block 10, 12 and 13: As required by Procurement Contracting Officer (PCO) approved Contract/Task Order.

Block 14: Deliver an electronic version (Microsoft format) on CD-R or other appropriate electronic means, along with a hard copy to the PM and

RDH Business Office. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

17. PRICE GROUP: 18.ESTIMATED TOTAL PRICE:

Andrew Greenwood

I. APPROVED BY: Mark Cruz

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 4 of 15 pages

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA

B. EXHIBIT .................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0004

C. CATEGORY .............................. : OTHER F. CONTRACTOR ...... :

1. DATA ITEM NO. ...................... : A005

2. TITLE OF DATA ITEM ........... : Test Plan

3. SUBTITLE ................................. : N/A

4. AUTHORITY ............................ : DI-NDTI-80566A (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : AFRL/RHDE 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : Lt 10.FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/PM’s Office 1

Block 4: The test plan (with attached appendices for safety, security, transportation, etc, as needed) shall be written IAW the template provided by the AFRL/RDH Test Director as specified in each task order/ contract.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD

5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to

Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION

STATEMENT TO THE BOTTOM OF EACH PAGE OF THE REPORT.)

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or

Block 10, 12 and 13: The document will be delivered 30 calendar days before the start of an experiment or demonstration to the PM and RDH

Business Office. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee. The document needs to be generated only once per Task, unless testing parameters or type change.

Block 14: Deliver an electronic version on CD, DVD ROM or other appropriate electronic means, along with a hard copy to the PM and RDH

Business Office. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

Andrew Greenwood

I. APPROVED BY: Mark Cruz

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 5 of 15 pages

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA

B. EXHIBIT .................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0004

C. CATEGORY .............................. : OTHER F. CONTRACTOR ....... :

1. DATA ITEM NO. ...................... : A006

2. TITLE OF DATA ITEM ........... : Computer Program End Item Documentation

3. SUBTITLE ................................. : N/A

4. AUTHORITY ............................ : DI-IPSC-80590B (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : AFRL/RHDE 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : Lt 10. FFRREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/PM’s Office) 1

Block 4: Paragraph 3.1.3. of the DATA ITEM DESCRIPTION. Executable programs. All executable programs and databases shall be delivered on

CD or DVD.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD

5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to

Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or

Block 10, 12 and 13: As specified in the task order/ contract.

Block 14: Deliver an electronic version on CD, DVD ROM or other appropriate electronic means, along with a hard copy to the PM and RDH

Business Office. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

Andrew Greenwood

I. APPROVED BY: Mark Cruz

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page _6 of 15 pages

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 I. SYSTEM/ITEM : Modeling and Effects Open BAA

B. EXHIBIT .................................... : A J. CONTRACT/PR NO. : FA9451-18-S-0004

C. CATEGORY .............................. : OTHER K. CONTRACTOR ....... :

1. DATA ITEM NO. ...................... : A007

2. TITLE OF DATA ITEM ........... : Software User's Manual

3. SUBTITLE ................................. : N/A

4. AUTHORITY ............................ : DI-IPSC-81443A (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : AFRL/RHDE 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : Lt 10. FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/PM’s Office 1

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD

5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to

Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or

Block 14 Deliver an electronic version (Microsoft format) on CD-ROM (CD-R) or other appropriate electronic means, along with a hard copy to the

PM and RDH Business Office. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

L. PREPARED BY:

Andrew Greenwood

I. APPROVED BY: Mark Cruz

M. DATE: 7 December 2017 J. DATE: 21 December 2017

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page _7 of 15 pages

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA

B. EXHIBIT .................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0004

C. CATEGORY .............................. : OTHER F. CONTRACTOR ....... :

1. DATA ITEM NO. ...................... : A008

2. TITLE OF DATA ITEM ........... : Technical Report

3. SUBTITLE ................................. : Study Services

4. AUTHORITY ............................ : DI-MISC-80508B (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : AFRL/RHDE 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : Lt 10. FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/PM’s Office 1

Block 4: Contractor Format. Tailoring will be specified in the Contract/Task Order.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD

5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to

Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or

Block 14: Deliver an electronic version (Microsoft format) on CD-ROM (CD-R) or other appropriate electronic means, along with a hard copy to the

PM and RDH Business Office. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

Andrew Greenwood

I. APPROVED BY: Mark Cruz

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page_ 8 of 15 pages

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA

B. EXHIBIT .................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0004

C. CATEGORY .............................. : OTHER F. CONTRACTOR ....... :

1. DATA ITEM NO. ...................... : A009

2. TITLE OF DATA ITEM ........... : Computer Software Product End Items

3. SUBTITLE ................................. : N/A

4. AUTHORITY ............................ : DI-AVCS-80700A (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : AFRL/RHDE 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : Lt 10. FREQUENCY……………………...: One 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ......................................... : N/A

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/PM’s Office 1

15. TOTAL: 2

Block 4: 1. Content. Required form is Contractor format. Tailoring will be specified in the Contract/Task Order.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD

5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to

Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or

Blocks 10, 12, and 13: As specified in the task order/ contract.

Block14: Deliver an electronic version on CD, DVD ROM or other appropriate electronic means, along with a hard copy to the PM and RDH

Business Office. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

Andrew Greenwood

I. APPROVED BY: Mark Cruz

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 9 of 15 pages

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA

B. EXHIBIT .................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0004

C. CATEGORY .............................. : OTHER F. CONTRACTOR :

1. DATA ITEM NO. ...................... : A010

2. TITLE OF DATA ITEM ........... : System Safety Hazard Analysis Report (SSHA)

3. SUBTITLE ................................. : N/A

4. AUTHORITY ............................ : DI-SAFT-80101C (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : AFRL/RDHE 9. DIST. STATEMENT REQUIRED ........ : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : Lt 10. FREQUENCY ....................................... : (See Block 16) 13. DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ....................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/PM’s Office 1

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD

5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to

Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

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 the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or

Blocks 10, 12, and 13: As specified in the task order/ contract.

Block14: Deliver an electronic version (Microsoft format) on CD-ROM (CD-R) or other appropriate electronic means, along with a hard copy to the

PM and RDH Business Office. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

17. PRICE GROUP: 18. ESTIMATED TOTAL PRICE:

G. PREPARED BY:

Andrew Greenwood

I. APPROVED BY: Mark Cruz

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 10 of 15 pages

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of

Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA

B. EXHIBIT .................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0004

C. CATEGORY .............................. : OTHER F. CONTRACTOR :

1. DATA ITEM NO. ...................... : A011

2. TITLE OF DATA ITEM ........... : Contract Funds Status Report (CFSR)

3. SUBTITLE ................................. : Quarterly Report

4. AUTHORITY ............................ : DI-MGMT-81468 (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : :

6. REQUIRING OFFICE .............. : AFRL/RDHE 9. DIST. STATEMENT REQUIRED ...... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : Lt 10. FREQUENCY ...................................... : (See Block 16) 13. DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ...................

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