0001AM_Time_Charge_Record.pdf

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM

NO. 0001AM

B. EXHIBIT

B

C. CATEGORY:

TDP TM OTHER X Technical

D. SYSTEM/ITEM

SUBSAFE MARINE MECHANICS

E. CONTRACT/PR NO.

N4523A-15-R-0003

F. CONTRACTOR

TBD

1. DATA ITEM NO.

0001AM

2. TITLE OF DATA ITEM

Time Charge Record

3. SUBTITLE

N/A

17. PRICE GROUP

4. Authority (DATA Acquisition document No.)

See Block 16

5. CONTRACT REFERENCE

SOW Para. 7 & 7.1

6. REQUIRING OFFICE

PSNS&IMF Code 413

18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

C

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

DD DAILY See Block16

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

See Block16 Draft

Final

N/A N/A Reg Repro

16. REMARKS Shop Supervisor 1

1. Block 12- Date of First Submission. The first submission of the TIME

CHARGE RECORD shall begin on the first day of the Period of Performance (POP) and is due at the end of each shift to the onsite Government Supervisor.

2. Block 13- Date of Subsequent Submissions: TIME CHARGE RECORD is required

DAILY for each day and shift any Contractor employee is supporting this order during the

POP.

3. Block 14- Distribution and addresses: Contractor shall hand deliver a copy of the TIME

CHARGE RECORDS at the end of each shift to the onsite Government Supervisor for signature and retain a copy. ORIGINAL TIME CHARGE RECORDS shall be submitted with invoices.

4. Submission Format and Instructions

4.1. Title: TIME CHARGE RECORDS FOR N4523A-15-R-0003, USS SEAWOLF (SSN-

21), USS CONNECTICUT (SSN-22), USS KENTUCKY (SSBN-737), USS NEBRASKA

(SSBN-739), USS OHIO (SSGN-726) and USS MICHIGAN (SSGN-727).

4.2 Designated Contractor Supervisor: The first block shall contain: Badge

Number, Supervisor Name, Ship, Date and Hours.

4.3 Certification of TIME CHARGE RECORDS: At the end of shift, Contractor and

Government Supervisor shall CERTIFY the time charged with their signature and badge number.

4.4 Designate Shift: Days, Swings or Graves shall be checked to designate the shift employees were present.

4.5 Designated Employees: Contractor employees shall provide their Badge Number, Their Name and Title, Signature and Hours.

5. Block 16 - Remarks:

5.1 Any changes after the Government Supervisor certifies the record will void the signature.

5.2 All changes will use a single line out with initials and date.

COR 1

15. TOTAL

G. PREPARED BY

Bart Franklin

H. DATE

13 April 2015

I. APPROVED BY

J. DATE