HHM402-23-S-0001_Cover Sheet.pdf

PART IV: APPENDIX B

NEEDIPEDIA WHITE PAPER COVERSHEET

WP Classification: Proprietary Data: Submission Date:

WP Title:

Offeror Organization:

BAA/CSO/CALL Number: This is the number of the BAA, CSO, or CALL

Need# or CALL ID#: This is the # of the specific Need# or CALL ID#

Need# or CALL ID# Title: This is title name of the Need# of CALL ID#

SAM.gov Unique Entity ID CAGE Code #: DUNS #:

2 Technical POC:

Name: Title:

Phone: Ext: Email:

3 Contracts POC:

Name: Title:

Phone: Ext: Email:

4 Mailing Address:

Street: City:

State: Country: Zip:

5 Physical Address:

(If different from above)

Street: City:

State: Country: Zip:

Organization Descriptors

(Select more than one if applicable)

Large Business Federally Funded Research & Development Center (FFRDC) Small Business IC CAE or Minority Servicing Institution (MSI)

(AANAPISI / HBCU / HSI / TCU) Non-Profit 8(a) Business Program Woman-Owned Small Business (WOSB) HUBZone Service-Disabled Veteran-Owned Small Business (SDVOSB) Academic Institution Foreign / Offeror not based in US o National Lab or UARC Other:

Requested Funding or

Contractual Instrument

BAA (FAR Based) Contract Type Requested:

CSO (FAR Based) Contract Type Requested:

Grant Other Transaction Authority (OTA) Cooperative Research and Development Agreement (CRADA) Other / Not Known / Not Declared Note:

Estimated Cost of Effort: Estimate Duration of Effort (Months):

Estimate the percentage of effort to be performed by the offeror & percentage of work by other team members (e.g., prime, subcontractor)

Offeror: % Team Members: %

Is the submitter a non-traditional defense contractor? (if yes, explain below) Yes No

If yes, explain:

Was DoD-reimbursed IR&D technology a foundation for the proposed approach? Yes No

Does the proposed submission derive from, extend, or complete efforts from prior federally funded SBIR or STTR projects? (If yes, provide details below)

Yes No

SIBR/STTR Topic Number:

SIBR/STTR Topic Name:

SIBR/STTR Agency:

SIBR/STTR Contract Number:

Have you ever done business previously with the DIA? Yes No

If “yes” – note how recently: Within the last 12 months 1 - 5 years ago Over 5 years ago

Additional Routing: Is there a US Government POC that is possibly interested in this submission or topic?

Yes No

USG POC 1

(If Not Applicable, Leave blank)

Name: Title:

Phone: Email:

USG POC 2

(If Not Applicable, Leave blank)

Name: Title:

Phone: Email:

List keywords or phrases separated by commas for this submission to aid search and discovery (text will scale to fit):

Filename of White Paper Cover Sheet: This is the file name for this file

Filename of Submitted White Paper: This is the file name for the two-page white paper

DIA NeedipeDIA Form 002 Version 7.7 - White Paper Cover Sheet Page 1 of 1

Note: Include this cover sheet form as a separate file when submitting white papers to ensure proper routing.