CDRL MD-05 Investigation Status Reporting.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved (1 Data Item) OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 220 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 the Department of Defense, Executive Services Directorate (0704-0188). 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 organization. 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:

TDP TM OTHER

Maint

D. SYSTEM ITEM E. CONTRACT/PR NO. F. CONTRACTOR

Logistic Support Services W52P1J-15-R-0195

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

MD-05 Investigation Status Reporting

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

PWS Para. 5.14.2 Maintenance Division/COR

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

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

NO See Blk 16 See Blk 16 b. COPIES

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

SUBMISSION

a. ADDRESSEE DRAFT FINAL

See Blk 16 See Blk 16 Reg Repro

16. REMARKS COR 1

Block 10 – As required by regulation or COR.

Block 11 – Date report produced.

Block 12 – As required by regulation or COR after notice to proceed date.

Block 13 – As required by regulation or requested by COR

Contractor format is acceptable.

a. The contractor shall provide reports, evaluations, and technical exhibits for equipment on work order which is under investigation or when required by the PCO or designated representative.

ALL DAYS INDICATED ARE CALENDAR DAYS UNLESS OTHERWISE

ANNOTATED.

Maintenance Division

15. TOTAL 2

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

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 1 of 1 Pages