CDRLs_192021.pdf

CONTRACT DATA REQUIREMENTS LIST I

Form Approved

OMB No 0704-0188 ' Public reporting burden for this collection of Information is estimated to average 440 hours per response, 1nclud1ng the time for rev1ew1ng Instructions, searching existing dat>J!

sources, gathering and maintaining the data needed, and completing and rev1ew1ng the collection of information Send comments regard1ng this burden estimate or any otherj aspect of this collection of information, mclud1ng suggest1ons for reduCing th1s burden, to Department of Defense, Washmgton Headquarters Serv1ces, Directorate to(;

Information Operat1ons and Reports, 1215 Jefferson Dav1s H1ghway, Su1te 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork ReductiC>ri ProJect (0704-01B8),Washlngton, DC 20503 Please DO NOT RETURN your form to either of these addresses Send completed form to the Government lssu1ng Contract1n~ Officer for the ContracVPR No. listed 1n Block E '

A. CONTRACT LINE ITEM NO. lB. EXHIBIT IC. CATEGORY:

TOP TM OTHER

D. SYSTEM / ITEM l E. CONTRACT I PR NO. r CONTRACTOR Range Support Services N00421 -11 -R-0066 '

1 DATA ITEM NO 2 TITLE OF DATA ITEM 3 SUBTITLE

CAC Revocation A019 Employee Termination ' ' '

4 AUTHORITY (Data Acquisition Document No) 15 CONTRACT REFERENCE 6 REQUIRING OFFICE

CDRL A019 ATR-010 SOW Section 3.3.7.4.1 ATR Air 5.2 .0 '

7 DD 250 REO 9. DIST STATEMENT

REQUIRED

10 FREQUENCY 12 DATE OF FIRST SUBMISSION 14. DISTRIBUTION

No per occurenc NL T3 working days after ' contractor termination . b COPIES

8. APP CODE 11 AS OF DATE 13 DATE OF SUBSEQUENT SUBMISSION a ADDRESSEE F1nal

N/A Draft Reg Repro !

16 REMARKS '

Must provide notification to Trusted Agent of employee termination and information Bldg 2118 1 0 ' ' regarding CAC retrieval from terminated employee. ' '

15. TOTAL --+ 1 0 ' '

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

A020 OT/HZ Duty Report 4 AUTHORITY (Data Acqwsttton Document No) 15 CONTRACT REFERENCE 6 REQUIRING OFFICE

CDRL A20 ATR-010 SOW Section 3.3.1.3.1 ATR Air 5.2.0

7 DD 250 REO 9 DIST STATEMENT

RFOt JIRFD

10 FREQUENCY 12 DATE OF FIRST SUBMISSION 14 DISTRIBUTION

No Monthly 60 DAC b COPIES

8 APP CODE 11 AS OF DATE 13 DATE OF SUBSEQUENT SUBMISSION a ADDRESSEE F1nal

N/A See Blk 16 Draft Reg Repro!

16 REMARKS ' ' NL T the 51 h working day of the following month Bldg 2118 1 0 ' ' '

All submissions will be via electronic media

15 TOTAL --+ 1 0

1 DATA ITEM NO 2 TITLE OF DATA ITEM 3 SUBTITLE

A021 Equipment Maintenance & Inventory Report Corrective Maintenance Report 4 AUTHORITY (Data Acqutsition Document No) r CONTRACT REFERENCE 6. REQUIRING OFFICE

01-MGMT-80277 See Block 16 ATR Air 5.2.0 7 DD250 REO 9 DIST STATEMENT 10 FREQUENCY 12 DATE OF FIRST SUBMISSION 14 DISTRIBUTION ' REQUIRED ' ' No Monthly Within 30 days of DAC ' b COPIES 8 APP CODE 11 AS OF DATE 13 DATE OF SUBSEQUENT SUBMISSION a ADDRESSEE Final ' '

N/A See Blk 16 Draft Reg Repro!

16 REMARKS

SOW Sections, 3.1.9.5.6, 3.1.31 .9, 3.3.5.3 Bldg 2118 1 0 NL T the 5th working day of the following month

All submissions will be via electron ic media

15 TOTAL --+ 1 0

' p PREPARED BY r DATE 1 APPROVED BY ~ DATE

~regory P Havens ~• ~ tfi;;~a.Ad l 09/26/2012 l _,tf.f-! tAk71..L ./ I 09/26/2012

DO Form 1423, Jun 90 Previous editions are obsolete Page I of j1Pages 1161/183

17 PRICE GROUP

18 ESTIMATED

TOTAL PRICE

17 PRICE GROUP

18 ESTIMATED

TOTAL PRICE

17 PRICE GROUP

18 ESTIMATED

TOTAL PRICE

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

Item 0 : 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.

ltemJ.

Signature of ODRL approval authority.

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 ltem4.

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 501 0.12-L (AM SOL), 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 oftimes 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 addresses 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 DO 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 DO 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 Ill. 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 requirement with regard to the depth of content, format, frequency of submittal , preparation , control , and quality of the data item.

Estimated Price - Costs to be included under Group Ill are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition - Data which is developed by the contractor as part of the 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 DO 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.