Exhibit A_CDRLs_N00421-10-R-0027.doc

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Reliability, Maintainability and System Safety Engineering and Technical Services
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N00421-10-R-0027
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Exhibit A - CDRLs

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CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

Form Approved

CMB 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract. PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

0004, 0104, 0204, 0304, 0404

B. EXHIBIT

A

C. CATEGORY

TDP

TM

OTHER

D. SYSTEM/ITEM

Reliability and Maintainability Engineering & Technical Support

E. CONTRACT/PID NO.

N00421-10-R-0027

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM:

System Requirements Development

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para: 4.1.1, 4.7.1

6. REQUIRING OFFICE

AIR 4.1.10.2

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

DISTRIBUTION

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2

22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

DD Form 1423-1, JUN 90 Previous editions are obsolete.

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract. PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

0004, 0104, 0204, 0304, 0404

B. EXHIBIT

A

C. CATEGORY

TDP

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A002

2. TITLE OF DATA ITEM:

Engineering Analyses

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para: 4.1.1, 4.2.1, 4.3.1, 4.6.1, 4.6.2, 4.9.1, 4.9.2, 4.9.5

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A003

2. TITLE OF DATA ITEM:

Technology Reviews, Reports and Papers

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para: 4.1.1, 4.2.1, 4.6.1

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A004

2. TITLE OF DATA ITEM:

Engineering Review of Government Furnished Data

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para: 4.1.1, 4.2.1, 4.3.1, 4.6.1, 4.6.2, 4.9.1, 4.9.2, 4.9.5

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A005

2. TITLE OF DATA ITEM:

System Design Analyses

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para: 4.2.1, 4.3.1, 4.6.1, 4.6.2, 4.9.1, 4.9.5

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A006

2. TITLE OF DATA ITEM:

Acquisition Documentation Analyses

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para: 4.1.1

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A007

2. TITLE OF DATA ITEM:

Data Collection

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para: 4.1.1, 4.4.1, 4.9.1, 4.9.4

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A008

2. TITLE OF DATA ITEM:

R&M Test Plans

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para: 4.3.1, 4.4.1

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A009

2. TITLE OF DATA ITEM:

R&M Test Reports

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para: 4.3.1, 4.4.1

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A010

2. TITLE OF DATA ITEM:

Reports/Minutes Record of Meetings

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para: 4.5.1, 4.9.3

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A011

2. TITLE OF DATA ITEM:

Technical Status Reports

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para: 4.1.1, 4.2.1, 4.3.1, 4.4.1, 4.5.1, 4.6.1, 4.9.1, 4.9.2, 4.9.3, 4.9.5

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A012

2. TITLE OF DATA ITEM:

R&M Models

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

DI-MCCR-80700

5. CONTRACT REFERENCE

PBWS Para: 4.7.2, 4.8.1, 4.9.4

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide software as required by task orders.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A013

2. TITLE OF DATA ITEM:

System Safety Hazard Analysis Report

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

DI-SAFT-80101A

5. CONTRACT REFERENCE

PBWS Para: 4.9.1, 4.9.3

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A014

2. TITLE OF DATA ITEM:

Safety Assessment Report

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

DI-SAFT-80102A

5. CONTRACT REFERENCE

PBWS Para: 4.9.2, 4.9.3

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A015

2. TITLE OF DATA ITEM:

ECP System Safety Report

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

DI-SAFT-80103A

5. CONTRACT REFERENCE

PBWS Para: 4.9.2, 4.9.3

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A016

2. TITLE OF DATA ITEM:

Operations Security (OPSEC) Plan

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80934

5. CONTRACT REFERENCE

PBWS Para: 9.3.1

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

See Block 16
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

N/A
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 10, 12 and 13: Provide data as required by task orders.

Electronic copies preferred.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A017

2. TITLE OF DATA ITEM:

Progress, Status and Management Report

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para: 9.1

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

Monthly
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

See Block 16
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools. Deliveries shall be made by both hardcopy and electronic means.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 11, 12 and 13: An individual report will be delivered for each task order. The first reports will be submitted 30 days after award. Each subsequent report will be submitted by the 15th of the month.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

Form Approved OMB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 440 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, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information, Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contract Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

B. EXHIBIT

A

C. CATEGORY

TDP

TM

OTHER

X

D. SYSTEM/ITEM

E. CONTRACT/PR NO.

F. CONTRACTOR

1. DATA ITEM NO.

A018

2. TITLE OF DATA ITEM

Status Report

3. SUBTITLE

Information Technology Personnel Security Report for COR

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80368 (see block 16)

5. CONTRACT REFERENCE

PBWS Para: 10.6

6. REQUIRING OFFICE

AIR 4.1.10.2

7. DD250 REQUIRED

DD

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

See Block 16

12. DATE OF FIRST SUBMISSION

See Block 16 14.

DISTRIBUTION

8. APP CODE

N/A

D
11. AS OF DATE

O

13. DATE OF SUBSEQUENT SUBMISSION

See Block 16

a. ADDRESSEE
b. COPIES

16. REMARKS

Draft
Final

Block 4: Digital media to be in IBM compatible Microsoft Excel 2000 or later format.

Contractor to submit IT Personnel Security Report for all employees requiring access to Government IT systems. Ensure that only the following information is included:

User’s Last Name; First Name; MI; Suffix; Exact Sigma User Name (if none – leave blank); Employee Type: Civ/Mil/CSS/FN; Contract No.; Customer AIR/PMA/PEO Code; Org: Hdqtrs/NAWC/NATEC, etc.; Duty Location; Work Email Address; IA Training Date (Verified by Transcript); Date of User Signature (SAAR Blk 12); Type of Investigation (SAAR Blk 28); Date Investigation Finalized (SAAR Blk 28a); Date Interim IT Level Designation (Stamp) Granted (SAAR Blk 28c) --do not put pending; Highest IT Level (SAAR Blk 28c); Date Security Verified Clearance/Investigation (SAAR Blk 32); Date COR Signature (SAAR Blk 19); COR Name (SAAR Blk 20); COR Email; Date Rec’d Sigma Customer Support Ctr.; Date System Access Granted & COR Notified; Date System Access No Longer Required; N-ERP IT System (if applic. Put N-ERP), Other IT System/s (separate by comma’s); Company Name.

Block 10: Updated report required within (30) days of gain or loss of employee(s) that have or will access Government IT systems

Block 12: First report is required (30) days after contract award

Block 13: Subsequent reports due (365) days after first report

Block 14: Electronic Encrypted Copy shall be provided

Reg
Repro

4.1.10.2

1
0

15. TOTAL

1
0

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

Form Approved OMB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 440 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, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information, Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contract Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

B. EXHIBIT

A

C. CATEGORY

TDP

TM

OTHER

X

D. SYSTEM/ITEM

E. CONTRACT/PR NO.

F. CONTRACTOR

1. DATA ITEM NO.

A019

2. TITLE OF DATA ITEM

Status Report

3. SUBTITLE

Information Technology Personnel Security Report for NAVAIR Security

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80368 (see block 16)

5. CONTRACT REFERENCE

PBWS Para: 10.6

6. REQUIRING OFFICE

AIR 4.1.10.2

7. DD250 REQUIRED

DD

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

See Block 16

12. DATE OF FIRST SUBMISSION

See Block 16 14.

DISTRIBUTION

8. APP CODE

N/ A

D
11. AS OF DATE

O

13. DATE OF SUBSEQUENT SUBMISSION

See Block 16

a. ADDRESSEE
b. COPIES

16. REMARKS

Draft
Final

Block 4: Digital media to be in IBM compatible Microsoft Excel 2000 or later format.

Contractor to submit IT Personnel Security Report for all employees requiring access to Government IT systems. Ensure that only the following information is included:

User’s Last Name; First Name; MI; Suffix; Exact Sigma User Name (if none – leave blank); Employee Type: Civ/Mil/CSS/FN; Contract No.; Customer AIR/PMA/PEO Code; Org: Hdqtrs/NAWC/NATEC, etc.; Duty Location; Work Email Address; IA Training Date (Verified by Transcript); Date of User Signature (SAAR Blk 12); Type of Investigation (SAAR Blk 28); Date Investigation Finalized (SAAR Blk 28a); Date Interim IT Level Designation (Stamp) Granted (SAAR Blk 28c) --do not put pending; Highest IT Level (SAAR Blk 28c); Date Security Verified Clearance/Investigation (SAAR Blk 32); Date COR Signature (SAAR Blk 19); COR Name (SAAR Blk 20); COR Email; Date Rec’d Sigma Customer Support Ctr.; Date System Access Granted & COR Notified; Date System Access No Longer Required; N-ERP IT System (if applic., put N-ERP); Other IT System/s (separate by comma’s); Company Name, SS# (only for NAVAIR Security) Block 10: Updated report required within (30) days of gain or loss of employee(s) that have or will access Government IT systems

Block 12: First report is required (30) days after contract award

Block 13: Subsequent reports due (365) days after first report

Block 14: Electronic Encrypted Copy shall be provided Note: Send Spreadsheet report only to NAVAIR Security.

Reg
Repro

AIR/AD 7.4.1 or Field Site Security Name

1
0

15. TOTAL

1
0

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract. PR No. listed in Block E.

B. CONTRACT LINE ITEM NO.

B. EXHIBIT

C. CATEGORY

TM

OTHER

D. SYSTEM/ITEM

E. CONTRACT/PID NO.

F. CONTRACTOR

1. DATA ITEM NO.

A020

2. TITLE OF DATA ITEM:

Quality Control Plan (QCP)

3. SUBTITLE:

As Designated

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PBWS Para 9.4 and Quality Assurance Surveillance (QASP) (Att 4)

6. REQUIRING OFFICE

7. DD 250 REQ

9. DIST STATEMENT REQUIRED
10. Frequency

12. DATE OF FIRST SUBMISSION

14.

XX

Monthly
See Block 16

b. COPIES

8. APP CODE
D
11. As of Date
13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Final

N/A

See Block 16
See Block 16
See Block 16
Draft
Reg.
Repro.

16. REMARKS

Block 4: Contractor format is acceptable. Documents and briefs shall be created using Microsoft Office tools.

Block 7: In accordance with clause 5252.246-9514 in Section E, data submitted for inspection and acceptance shall be accompanied by NAWCTSD Form 4330/60 provided as Attachment 3.

Block 9: Distribution authorized to Department of Defense and DoD Contractors only. Data is for administrative/operational use.

Blocks 11, 12 and 13: An individual report will be delivered for each task order. The first reports will be submitted 30 days after award. Each subsequent report will be submitted by the 15th of the month.

Copies are to be sent to the associated task order sponsor.

The COR’s address is Mr. Babuchiwski, AIR 4.1.10.2 22689 Saufley Rd, Patuxent River, MD 20670-5304 e-mail: peter.babuchiwski@navy.mil

AIR 4.1.10.2

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

_1251625055.xls SAAR Info

User's
Last NameFirst NameMISuffixExact Sigma User Name* (if none -- leave blank)Employee Type: Civ / Mil / CSS / FNContract No.Customer AIR/PMA/PEO CodeOrg: Hdqtrs/ NAWC / NATEC, etcDuty LocationWork email addressIA Training Date
(Verified by Transcript)Date of User Signature
(SAAR Block 12)Type of Investigation
(SAAR Blk 28)Date Investigation Finalized
(SAAR Blk 28a)Date Interim IT Level Designation (Stamp) Granted (SAAR Blk 28c)-do not put pendingHighest IT Level SAAR Blk 28cDate Security Verified Clearance/Investigation (BKL 32)Date of COR Signature on SAAR
(Blk 19)COR
Name (Blk 20)COR
EmailDate Rec'd
Sigma Customer Support CtrDate System Access Granted and COR NotifiedDate System Access No Longer RequiredN-ERP IT System (if applic., put N-ERP)Other IT System/s (separate IT system by comma's)Company Name

Example: Smith John A Jr SmithJA CSS N68936-06-D-0478 NAWCWD China Lake John.Smith.CTR@navy.mil 4/25/07 4/25/07 NACLC 12/25/05 3 5/3/07 5/1/07 Joe Navy Joseph.Navy@navy.mil N-ERP EDA, NOD XYZ

* to find Sigma user Name on Sigma Website:

go to https://sigma.navair.navy.mil/ & under "What's New" section, click on Sigma User Name Spreadsheet

&C&14Information Technology Personnel Security Report for the COR&10

Sheet2

Duty Location Company Code Emp

NAVAIR HQ Patuxent River, MD HQ Civ

NAVAIR HQ North Island, CA TSD Mil

NAVAIR HQ China Lake, CA NAPRA CSS

NAVAIR HQ Jacksonville, FL NATEC FN

NAVAIR HQ Lakehurst, NJ NAWCAD

NAVAIR HQ Pt Mugu, CA NAWCWD

NAPRA Atsugi, Japan Non NAVAIR

NAWCTSD Orlando, FL

NATEC North Island, CA

NAWCAD Patuxent River, MD

NAWCWD China Lake, CA

NAWCWD Pt Mugu, CA

NAWCAD Lakehurst, NJ

_1251625154.xls Privacy Act Notice

Privacy Act Notice

This spreadsheet will contain Privacy Act Data information upon completion which shall be safeguarded in accordance with the Privacy Act of 1975. Electronic transmittal of the spreadsheet to the NAVAIR Security office (as required by the CDRL) shall be encrypted. The contractor assumes all liability for loss or inadvertent release of information if this data is transmitted by any other means, is released by the contractor to any other parties, or if the data is compromised via storage on the contractor's computer system.

SAAR Info

User's
Last NameFirst NameMISuffixExact Sigma User Name* (if none -- leave blank)Employee Type: Civ / Mil / CSS / FNContract No.Customer AIR/PMA/PEO CodeOrg: Hdqtrs/ NAWC / NATEC, etcDuty LocationWork email addressIA Training Date
(Verified by Transcript)Date of User Signature
(SAAR Block 12)Type of Investigation
(SAAR Blk 28)Date Investigation Finalized
(SAAR Blk 28a)Date Interim IT Level Designation (Stamp) Granted (SAAR Blk 28c)-do not put pendingHighest IT Level SAAR Blk 28cDate Security Verified Clearance / Investigation (BKL 32)Date of COR Signature on SAAR
(Blk 19)COR
Name (Blk 20)COR
EmailDate Rec'd

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated .