II.G. Att(2)_CDRL A001_Redacted.pdf

CONTRACT DATA REQUIREMENTS LIST

Form Approved

(1 Data Item) 0MB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 110 hours per response, including tile time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comment s regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Service, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Al1ington, VA 22202-4302, and to the Office of Management and Budget, PapelWOf1< Reduction Project (0704-0188), Washi1gton, DC 20503. Please DO NOT RETURN your form to either of tllese addresses. Send completed form to tile Government Issuing Contracting Officer for tile Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

I

B. EXHIBIT C. CATEGORY

0006 A

TOP TM OTHER MISC

D. SYSTEM/ITEM

liiiiiiiiiill

F. CONTRACTOR

Security Medical Evaluations ----

1. DATA ITEM NO. 2. TITLE OF DATA ITEM: 3. SUBTITLE

A00l Technical Reports - Study/Services Medical Evaluation

4. AUTHORITY (Date Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE DI-MISC-80508B SOW Para 5.0 NUWCDIVNPT Code 1051

7. DD 250 REQ 9. DIST STATEMNT 10. FREQUENCY 12. DATE OF FIRST 14. DISTRIBUTION

REQUIRED SUBMISSION

LT See BLK 16 See BLK 16 b. COPIES

8. APPCODE F 11. AS OF DATE 13. DATE OF SUBSEQNT

SUBMISSION

a. ADDRESSEE Draft

Final

N/A See BLK 16 N/A N/A Reg Repro

16. REMARKS Code 1051 0 1 0

BLK 1 - Contractor's format is acceptable

BLK 9 - See BLK 16

BLK 10: One ( 1) report per evaluation conducted, ten

(10) reports per contract year

BLK 12: Contractor shall deliver Medical Evaluation within seven (7) calendar days of evaluation.

BLK 14: Report may be transmitted electronically using the AMRDEC Safe Access File Exchange (SAFE) at https://safe.amrdec.army.mil/SAFE/. This site requires a specific email address to which to send documents -use -

Additional options that should be selected when using SAFE include:

- Encrypt email message when possible

- Require CAC for Pick-up -Mark "FOUO" and "Protected by Privacy Act" under the Other drop down list

15. TOTAL 0 l 0

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

DD Fonn 1423-1, feb 2001 Previous Edition May be Used Page ..L of _2_ Pages

17 PltlC't GROUP

18. ISIUIATm

1JTAL PRICE

DD FORM 1423, CONTRACT DATA REQUIREMENTS LIST

BLOCK 16 ADDENDUM

N6660420P8028

CDRL A001 to A01Y:

BLOCK 9: The following information is provided in amplification of the Block 9 Distribution Statement shown on each DD FORM 1423.

Distribution Statement paragraphs are in addition to CLASSIFICATION markings of the data.

CDRL A001

Distribution Statement F: Further dissemination only as directed by Code 105, Naval Undersea Warfare Center Division, Newport, Newport, RI, [09/17/2020], or higher DoD Authority under Specific Authority Privacy Act of 1974.

The following 'EXPORT CONTROL WARNING NOTICE' must be used in conjunction with DISTRIBUTION STATEMENTS identified the CDRL:

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 (Title 50, U.S.C., App. 2401 et seq.), as amended, Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.