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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 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

16. REMARKS (Continued)

DD FORM 1423-1, FEB 2001 Page of Pages

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package;

TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

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

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

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

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

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

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

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

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

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

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

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

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

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).

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

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

Item 12. Specify when first submittal is required.

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

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

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

Item 16. Use for additional/clarifying information for Items 1 through 15.

Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

FOR THE CONTRACTOR

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

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

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

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

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

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

Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and

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

data_item: A009 title: MEUAS IV Daily Status Report sub: DSR auth: DI-MGMT-80368A ref: PWS PARA 5 req_ofc: USSOCOM SOF AT&L-FW dd250: DD appcode: A dist: C freq: See Blk 16 asof: N/A firstsub: See Blk 16 subsub: N/A addressee1: SOF AT&L-FW (COR) draft1: 1 reg1: 1 repro1:

addressee2: USG Site Rep (GSR) draft2: 1 reg2: 1 repro2:

addressee3: SOF AT&L-KF (PCO) draft3: 0 reg3: 1 repro3:

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total_draft: 2 total_reg: 3 total_repro: 0 remarks: Block 4: Complete using Government provided format (attached). Content shall include a) hours utilized; b) sorties flown; c) sortie results or achievements; d) status of equipment; e) a brief description of any incidents and mishaps; f) justification for any canceled/delayed sorties.

Block 10: Required after flight mishap, or significant ground or flight incident that could potentially lead to a flight mishap on NIPR and SIPR.

Block 12: Submit report daily at 1200Z.

Block 13: Only one submission is required per day. If further information is required beyond the initial SITREP additional updates shall be sent to the requesting government representative through the USSOCOM SOF AT&L PEO-FW Contracting Officer.

Block 14: Electronic transmission of data, on NIPR and SIPR, is the preferred method of delivery.

group:

total_price:

prep_name: James Curran Capt USAF line_item: X003, X004, X005, X006 exhibit:

xtdp: Off xtm: Off othercat: MGMT system: MEUAS IV ISR Services ctr_no: H9240819R0001 contr:

remarksb:

Page2: 2

Reset:

2019-08-19T10:57:37-0400

CURRAN.JAMES.WILLIAM.1291053188

prep_date: 20190819 app_by:

2019-09-20T09:57:37-0400

HARDWICK.JAMES.W.1277537857

app_date: 20190920

Page: 1 of_pages: 2 app: Adobe Professional 8.0

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A010 title: MEUAS IV Spectrum Certification Data sub:

auth: DI-EMCS-81827 ref: PWS Para 5 req_ofc: USSOCOM SOF AT&L-FW dd250: LT appcode: N/A dist: D freq: ONCE asof: N/A firstsub: SEE BLK16 subsub: SEE BLK16 addressee1: SOF AT&L-FW (COR) draft1: 0 reg1: 1 repro1:

addressee2: SOF AT&L-KF (PCO) draft2: 0 reg2: 1 repro2:

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total_draft: 0 total_reg: 2 total_repro: 0 remarks: BLK 4: A complete DD Form 1494 and supporting documentation shall be submitted for each spectrum-dependent system utilized on the contractor's platform.

BLK 9: The following information shall be included on the deliverable: DISTRIBUTION STATEMENT D: Distribution authorized to the DoD and U.S. DoD contractors only; Critical Technology; ***Date of Delivery Order***. Other requests shall be referred to :

UNITED STATES SPECIAL OPERATIONS COMMAND

SOF AT&L/PEO-FW

7701 TAMPA POINT BLVD.

MACDILL AFB, FL 33621

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. Violation of these export laws are subject to severe criminal penalties. Disseminate in accordance with the provisions of DoD Directive 5230.25.

BLK 12 & 13: Submissions are due 10 days after task order award or upon any proposed changes to spectrum-dependent systems during the execution of a task order.

BLK 14: Regular copies e-mail addresses:

SOF AT&L-FW: james.w.hardwick.mil@socom.mil SOF AT&L-KF: jennifer.metty@socom.mil SOF AT&L-KF: tahnee.yon@socom.mil Any Contracting Officer at SOF AT&L can change the POCs via e-mail notification to the contractor and without issuing a formal modification to this contract.

group:

total_price:

prep_name:

line_item: X003, X004, X005, X006, X009 exhibit:

xtdp: Off xtm: Off othercat: "Spectrum Certification" system: MEUAS IV ISR Services ctr_no: H9240819R0001 contr:

remarksb:

Page2: 2

Reset:

2019-09-20T09:57:58-0400

HARDWICK.JAMES.W.1277537857

prep_date: 20190819 app_by:

2019-09-20T09:58:10-0400

HARDWICK.JAMES.W.1277537857

app_date: 20190920

Page: 1 of_pages: 2 app: Adobe Professional 8.0

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A001 title: MEUAS IV Pre-Deployment Site Survey Report sub: PDSS Report auth: DI-MGMT-81381 ref: PWS Para 5 req_ofc: USSOCOM SOF AT&L-FW dd250: DD appcode: A dist: C freq: See Blk 16 asof: N/A firstsub: See Blk 16 subsub: See Blk 16 addressee1: SOF AT&L-FW (COR) draft1: 1 reg1: 1 repro1:

addressee2: USG Site Rep (GSR) draft2: 1 reg2: 1 repro2:

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total_draft: 2 total_reg: 3 total_repro: 0 remarks: Block 4: Contractor format acceptable. Contents shall include: a) Title Page including the CDRL number, contract number, contractor, date; b) Introduction including the location, dates of survey, personnel conducting survey, personnel contacted on-site; c) Results including a complete description of the contractor's findings, an explanation of concerns with on-site conditions; d) Conclusions including a summary of the results of the survey and recommendations the contractor has based on the survey.

Block 5: PWS: 3.1, 3.1.1, 3.1.7, 3.1.12, 3.8, 3.9, 3.10.1

Block 8: Content approval.

Blocks 10, 12 & 13: Contractor approved Pre-Deployment Site Survey (PDSS) Report is required 14 days after site survey completion. Final PDSS report shall incorporate any required changes as a result of Government review and comments. Final/approved PDSS report shall be provided to the U.S. Government Site Representative (GSR) prior to site being designated as operational.

Block 14: Electronic transmission of data is the preferred method of delivery.

group:

total_price:

prep_name:

line_item: X001, X002 exhibit:

xtdp: Off xtm: Off othercat: MGMT system: MEUAS IV ISR Services ctr_no: H9240819R0001 contr:

remarksb:

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Reset:

2019-09-20T09:50:39-0400

HARDWICK.JAMES.W.1277537857

prep_date: 20190920 app_by:

2019-09-20T09:50:56-0400

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app_date: 20190920

Page: 1 of_pages: 2 app: Adobe Professional 8.0

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A002 title: MEUAS IV Site Specific Standard Operating Procedure (SOP) sub: SOP auth: DI-MGMT-815080 ref: PWS Para 5 req_ofc: USSOCOM SOF AT&L-FW dd250: DD appcode: A dist: C freq: See Blk 16 asof: N/A firstsub: See Blk 16 subsub: See Blk 16 addressee1: SOF AT&L-FW (COR) draft1: 1 reg1: 1 repro1:

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total_draft: 2 total_reg: 3 total_repro: 0 remarks: Block 4: Contractor format acceptable.

Block 8: Content approval.

Blocks 10, 12 & 13: Contractor approved site specific Standard Operating Procedure is required 5 days prior to scheduled start of deployment operations at site location. Final Standard Operating Procedure shall incorporate any required changes as a result of Government review and comments. Final/approved standard operating procedures shall be provided to the U. S. Government Site Representative (GSR) prior to site being designated as operational. Subsequent revisions and submissions shall be "as required", after significant deployment site procedure changes have been documented.

Block 14: Electronic transmission of data is the preferred method of delivery.

group:

total_price:

prep_name:

line_item: X001 exhibit:

xtdp: Off xtm: Off othercat: MGMT system: MEUAS IV ISR Services ctr_no: H9240819R0001 contr:

remarksb:

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Reset:

2019-09-20T09:52:38-0400

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prep_date: 20190920 app_by:

2019-09-20T09:52:49-0400

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app_date: 20190920

Page: 1 of_pages: 2 app: Adobe Professional 8.0

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A003 title: MEUAS IV Monthly Status Report sub: MSR auth: DI-MGMT-80368A ref: PWS Para 5 req_ofc: USSOCOM SOF AT&L-FW dd250: DD appcode: A dist: C freq: See Blk 16 asof: N/A firstsub: See Blk 16 subsub: See Blk 16 addressee1: SOF AT&L-FW (COR) draft1: 1 reg1: 1 repro1:

addressee2: USG Site Rep (GSR) draft2: 1 reg2: 1 repro2:

addressee3: SOF AT&L-KF (PCO) draft3: 0 reg3: 1 repro3:

addressee4:

draft4:

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total_draft: 2 total_reg: 3 total_repro: 0 remarks: Block 4: Format shall be compatible with Microsoft Office. Content shall include a) a GSR statement of validation; b) a summary of daily operational activity and total monthly activity; c) a summary of activities to support USG measures of performance outlined in the PWS Para 3.9.4; d) a detailed description of any incidents to include hard landings and crashes, any equipment damaged, and USG recovery efforts; e) training, qualification status, and current assignment of on-site workforce.

Block 8: Content approval.

Block 12: Initial submittal required on the 10th calendar day of the month, no earlier than 21 days after site activation.

Block 13: Subsequent submittals required on the 10th calendar day of each month of active task order.

Block 14: Electronic transmission of data is the preferred method of delivery.

group:

total_price:

prep_name:

line_item: X003, X004, X005, X006 exhibit:

xtdp: Off xtm: Off othercat: MGMT system: MEUAS IV ISR Services ctr_no: H9240819R0001 contr:

remarksb:

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Reset:

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HARDWICK.JAMES.W.1277537857

prep_date: 20190920 app_by:

2019-09-20T09:53:20-0400

HARDWICK.JAMES.W.1277537857

app_date: 20190920

Page: 1 of_pages: 2 app: Adobe Professional 8.0

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A004 title: MEUAS IV System Logs/Data Files sub: Telemetry Files auth: DI-MGMT-80368A ref: PWS Para 5 req_ofc: USSOCOM SOF AT&L-FW dd250: DD appcode: A dist: C freq: See Blk 16 asof: N/A firstsub: See Blk 16 subsub: See Blk 16 addressee1: SOF AT&L-FW (COR) draft1: 1 reg1: 1 repro1:

addressee2: SOF AT&L-KF (PCO) draft2: 0 reg2: 1 repro2:

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total_draft: 1 total_reg: 2 total_repro: 0 remarks: Block 4: Contractors format acceptable.

Block 8: Content approval.

Block 10: As directed by PCO / COR.

Block 12 & 13: As directed by PCO / COR.

Block 14: Electronic transmission of data is the preferred method of delivery.

group:

total_price:

prep_name:

line_item: X003, X005, X006, X009 exhibit:

xtdp: Off xtm: Off othercat: MGMT system: MEUAS IV ISR Services ctr_no: H9240819R0001 contr:

remarksb:

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prep_date: 20190920 app_by:

2019-09-20T09:53:57-0400

HARDWICK.JAMES.W.1277537857

app_date: 20190920

Page: 1 of_pages: 2 app: Adobe Professional 8.0

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A005 title: MEUAS IV Quality Control Plan sub: Quality Control Plan auth: DI-MGMT-81304 ref: PWS Para 5 req_ofc: USSOCOM SOF AT&L-FW dd250: DD appcode: A dist: C freq: See Blk 16 asof: N/A firstsub: See Blk 16 subsub: See Blk 16 addressee1: SOF AT&L-FW (COR) draft1: 1 reg1: 1 repro1:

addressee2: SOF AT&L-KF (PCO) draft2: 1 reg2: 1 repro2:

addressee3:

draft3:

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total_draft: 2 total_reg: 2 total_repro: 0 remarks: Block 4: Contractor format acceptable.

Block 10, 12, and 13: The draft Quality Control Plan shall be submitted no later than 30 days prior to the scheduled start of deployment operations. The Government will review and may reply with comments within 15 days or receipt. The final Quality Control Plan shall be implemented with the scheduled start of deployed site operations. Subsequent updates to the Quality Control Plan will be reviewed by the Government before implementation when changes become necessary.

Block 14: Electronic transmission of data is the preferred method of delivery.

group:

total_price:

prep_name:

line_item: X001, X002, X003, X005, X006 exhibit:

xtdp: Off xtm: Off othercat: MGMT system: MEUAS IV ISR Services ctr_no: H9240819R0001 contr:

remarksb:

Page2: 2

Reset:

2019-09-20T09:55:11-0400

HARDWICK.JAMES.W.1277537857

prep_date: 20190920 app_by:

2019-09-20T09:55:20-0400

HARDWICK.JAMES.W.1277537857

app_date: 20190920

Page: 1 of_pages: 2 app: Adobe Professional 8.0

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A006 title: Information Assurance Submission(s) sub: IA Submissions auth: DI-MGMT-ref: PWS Para 5 req_ofc: USSOCOM SOF AT&L-FW dd250: DD appcode: A dist: C freq: See Blk 16 asof: N/A firstsub: See Blk 16 subsub: See Blk 16 addressee1: SOF AT&L-FW (COR) draft1: 1 reg1: 1 repro1:

addressee2: SOF AT&L-KF (PCO) draft2: 0 reg2: 1 repro2:

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total_draft: 1 total_reg: 2 total_repro: 0 remarks: Block 4: Contractor format acceptable.

Block 8: Content approval.

Block 10: As directed by PCO / COR.

Block 12 & 13: As directed by PCO / COR.

Block 14: Electronic transmission of data is the preferred method of delivery.

group:

total_price:

prep_name:

line_item: X003, X004, X005, X006, X009 exhibit:

xtdp: Off xtm: Off othercat: MGMT system: MEUAS IV ISR Services ctr_no: H9240819R0001 contr:

remarksb:

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Reset:

2019-09-20T09:55:40-0400

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prep_date: 20190920 app_by:

2019-09-20T09:55:48-0400

HARDWICK.JAMES.W.1277537857

app_date: 20190920

Page: 1 of_pages: 2 app: Adobe Professional 8.0

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A007 title: MEUAS IV System Mishap/Safety Investigation Report sub: Mishap Report auth: DI-SAFT-81563 ref: PWS Para 5 req_ofc: USSOCOM SOF AT&L-FW dd250: DD appcode: A dist: C freq: See Blk 16 asof: N/A firstsub: See Blk 16 subsub: See Blk 16 addressee1: SOF AT&L-FW (COR) draft1: 1 reg1: 1 repro1:

addressee2: USG Site Rep (GSR) draft2: 0 reg2: 1 repro2:

addressee3: SOF AT&L-KF (PCO) draft3: 1 reg3: 1 repro3:

addressee4:

draft4:

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total_draft: 2 total_reg: 3 total_repro: 0 remarks: Block 4: Contractor format acceptable.

Block 10: Required after flight mishap, or significant ground or flight incident that could potentially lead to a flight mishap.

Block 12: A Quick Look Report shall be sent to ghostfwd@jdi.socom.mil and isr_ghost@socom.mil within one hour of a system mishap, loss of Government Furnished Property, or a safety investigation. Quick Look Report shall include all critical information known at the time of the report. Data in question should be provided but annotated as under investigation. A detailed mishap or incident report is required electronically within 24 hours unless an extension is approved by the USSOCOM SOF AT&L PEO-FW Contracting Officer. The detailed report shall be sent to 1JSOACISR@soc.smil.mil, ghostfwd@jdi.socom.mil, isr_ghost@socom.mil, the SOF AT&L-FW COR, USG Site Rep (GSR) and the SOF AT&L PEO-FW Contracting Officer (PCO). If further investigation is required beyond the 24 hour window, additional updates will shall be sent to ghostfwd@jdi.socom.mil, isr_ghost@socom.mil, the SOF AT&L-FW COR, USG Site Rep (GSR) and the SOF AT&L PEO-FW Contracting Officer (PCO).

DEFINITIONS:

Quick Look Report -- must include "Who, What, When, Where, Why/How" information deemed "critical" by USSOCOM SOF AT&L PEO-FW personnel.

Detailed Look Report -- must include observations that may have contributed to the mishap. Include all relevant environmental, electromagnetic interference, and other factors or parameters that caused the platform to function incorrectly. Also include the impact to operations, and recommendations for further investigation if required..

Block 14: Electronic transmission of data is the preferred method of delivery.

group:

total_price:

prep_name:

line_item: X003, X005, X006, X008, X009 exhibit: A xtdp: Off xtm: Off othercat: SAFETY system: MEUAS IV ISR Services ctr_no: H9240819R0001 contr: TBD remarksb:

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Reset:

2019-09-20T09:56:15-0400

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prep_date: 20190920 app_by:

2019-09-20T09:56:23-0400

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app_date: 20190920

Page: 1 of_pages: 2 app: Adobe Professional 8.0